The Librarian and Michelle Evans

In four separate monthly staffings for patients at EMHC in the last two days, the issue of the librarian came up. The facility library is a generally undervalued resource for patients, who are almost completely restricted from internet use, and of course, cannot have computers in their rooms. The ways that normal people get information in the real world are simply not available; "patients" are in fact cut off from much communication with the world. This is classic milieu control as described by Robert Lifton. It is the most basic feature of an environment geared to impose thought reform on individuals.

I believe this is actually contrary to the Illinois Mental Health and Developmental Disabilities Code, at least in principle. In any event, access to the library becomes an even more critical right, and denial of such access is a particularly cruel mechanism of control, similar to close restriction or overregulation of telephone use or mail, or even solitary confinement (called seclusion in psychiatric "hospitals").

I've never surveyed how many or what percentage of "patients" at EMHC use the library frequently or at all, and how important they consider it to be to their own mental and emotional welfare and recovery. It occurs to me that it might be extremely important. Thus, making the library a dangerous or unpleasant place at EMHC could become a strategy for control or punishment.

If the EMHC library were a place (just hypothetically) where "patients" were often required to dodge sexual harassment or grooming to become sexual abuse victims, that would be a serious human rights violation. On the other side of this, if a staff at EMHC were a sexual predator, the very best job he or she could hope for might be Librarian. 

Vulnerable people could be found in the library, and privacy could be easily arranged. If (just hypothetically) a librarian at EMHC had a special proclivity for African American women as objects of erotic interest, he might be tempted to give out his private phone number to the young, pretty ones. He might spend evenings telling them how special they are, and how he'd love to be with them. He might operate that way with impunity, for years.

But the thing is, Michelle Evans is a long-time EMHC clinician (social worker) and current Hospital Administrator (i.e., the top dog, the master up in the big house with the most authority on the whole plantation). She is very highly qualified as an expert in identifying and dealing with sexual predators, and has been on the board of directors of the not-for-profit Illinois Association for the Treatment and Prevention of Sexual Abuse, since 2014!

Barry Smoot told me he believes there is much more sexual abuse of patients in IDHS custody than almost anyone even imagines, certainly far more than what gets reported to OIG. Barry and I were recently talking about what records might reveal the number of female patients who became pregnant in, say, the last five or ten years, while they were in IDHS custody. Of course most of the time, the men who get them pregnant would be other patients, not staff.... Right?

But with an expert like Michelle Evans, even a librarian couldn't get away with that at EMHC.

Right??

Happy New Year!

Gus: So tell me Joe... What can I do to make our relationship better and more productive?

Joe Basso: What?

Gus: Tell me what I can do to improve this social worker-patient relationship between you and me?

Joe Basso: (Long pause...) Well, um....What do you mean?

Gus: I just mean, is there anything... something that I can do to make this better, so that you and I can work together?

Joe Basso: (Looking away, looking up at the ceiling...) Uh... I'm not sure what you're talking about.... What do you mean by that?

This conversation, or a very close, nearly word-for-word version of it, actually occurred this morning on N Unit at EMHC. Gus is the guy whom everyone (at least according to Vik Gill) supposedly dislikes more than any other patient. Joe, officially assigned as Gus' caseworker, actually doesn't even work on the same clinical unit. He was assigned to Gus after Xiaomara Ramirez apparently became worried that Gus might accuse her of doing unethical things with male patients in her office, while the window in the door was papered over so no one could see in.

Gus never did accuse Xiaomara of any such misconduct, he only mentioned the obstructed view through her office door window, which was in fact against clear facility policy. I was the one who recalled an earlier pattern of misconduct by an EMHC social worker. A male patient was sexually abused, several times a week for years, in an office just like Xiaomara's, on a clinical unit just like N Unit. That social worker was convicted on felony charges and sentenced to a prison term. The state was then forced to defend various individuals who worked within steps of the door to the office where the sexual abuse occurred, against claims that they failed or refused to prevent the resulting harm. That civil case was litigated for nearly seven years before it finally settled.

But in any event, Xiaomara kind of freaked out, and insisted on dumping Gus from her case load some months back. Joe Basso was the low-ranking staff conscripted to take over. His office is on M Unit, which is separate from N Unit. Gus cannot go over to M to talk to his social worker, and Joe doesn't come to N any more often that he absolutely has to, so they don't talk much. It's awkward, clearly not very attuned to any therapeutic purpose, and Joe seems to resent Gus for that. But after all, Gus is disliked more than any other patient at EMHC, as certified by Dr. Gill, M.D. psychiatrist. Thus, Joe can feel easily justified for disliking Gus, too.

The thing about all this is, it's a painfully clear demonstration of the fact that the so-called "mental health professionals" who man the psychiatric slave plantations for which Illinois taxpayers spend about a billion dollars a year really have no idea what they are doing. They are not real doctors who have real scientific medicine to help anyone recover from real illnesses. They are shysters, merely desperate to feed at a rapidly dwindling public trough.

At best, they are apparatchiks who wanted to help people a long time ago, but don't think about that anymore because they're only hiding in the machine, hoping no one will see them so they can survive long enough to get a pension.

Gus sees them. When he asks Joe Basso what he can do to help things improve, Joe can't even think with that question. All Joe wants is no trouble. Help is incomprehensible.

This state should abolish psychiatric slavery. Close EMHC!

A culture of corruption

Yesterday's Chicago Tribune had a front page article entitled, "Excessive overtime at IDHS detailed: Agency also facing increased allegations of staff misconduct," by Jeremy Gorner. IDHS corruption is such old news to me that I had to push myself to even read the article.

Excessive overtime--? Come on! If you want to talk about staff misconduct, how about looking for rampant and entrenched sexual abuse and medical neglect of involuntary "patients" (who are actually slaves), paid for by the taxpayers of this state? How about the fact that everyone believes the slaves are held for their own good and for the protection of the community, but when they are released they are worse than they ever were, and more dangerous to themselves and others, because they're angry and trained to lie?

If some STA on a $66,000 annual salary manages to gross $227,800 by logging 3321 hours of overtime, how is that more corrupt than the clinicians who bury their heads in the sand so they "don't see" (and never have to report) such obvious signs of abuse as the close relationship between Gabby and Latwon on K &  L, or Malis-with-malice's chaining of a disabled James Baker merely to punish him, or the consistent, continuing neglect of Gus on N Unit?

Why was a baby conceived on White Cottage, and nobody really knew whether the father might be staff? Why do senior clinicians and administrators have impunity to "document" falsehoods about patients that become "medical record" for courts to accept as reliable and relevant evidence? Why are these people almost never  prosecuted for perjury and other crimes? Why the hell do we all think this is OK, or the way it has to be?

The Trib article goes on and on about the difficulties of maintaining head counts. But the real reason there are too few staff on the plantations is that no one wants to work in this psychiatric slavery industry any more. New staff start because they believe "mental health care" is a good way to help people. Then they find out pretty early that it's not possible to help the way they had hoped to, on the plantations. They get demoralized and cynical and before they know it, if they don't leave for more honest work, they become cogs in the wheels of the abuse and neglect machine, which just runs.

No "staffing analysis" will ever change the fundamentally corrupt culture in IDHS, as long as the Department is devoted to a false promise of medical cures for non-medical problems in human thinking, emotion and behavior.

While psychiatry rules, excessive overtime is the least of problems.

You may compromise patient safety

A recent comentary in JAMA Open Network highlights recent research indicating that empathy and respect for patients, in communications between clinicians, may enable better information recall and thereby avoid negative impacts on patient safety and quality of care. 

Empathy and respect for patients may seem like an obvious value under the old "bedside manner" rubric, but that's not what this is about. The research now shows that when one clinician tells another clinician something negative or stigmatizing about a particular patient, that communication hurts the patient's safety and the quality of care. When it's a cultural habit (as it often is) among medical staff, medicine itself is less effective.

But almost every "patient" I ever knew in Illinois' forensic psychiatric system, i.e., on the plantations in Elgin, Chester, Chicago, Springfield, Anna, Alton... is stigmatized, disrespected, and described negatively by staff. Staff presume patients are all defective, mentally disordered. Nobody can tell exactly what is wrong (supposedly, with their brains), so it's just thought to be a general constitutional inferiority, a fault or a subhumanity: staff really can't respect or empathize with these guys, because their vaguely defined (fake, psychiatric) "illnesses" make them uniquely a nuisance and unpredictable, always hard to understand, often dangerous. 

In fact, psychiatric "diagnoses" are nothing more than epithets. They never help or enable improvement. They're negative, stigmatizing tales about people, meant only to justify brute control. That doesn't necessarily imply condemnation of voluntary psychiatry, or of any particular psychiatrist's specific practices, as harmful to patients who give truly informed consent. My biggest objection has always been to the total dishonesty, the fraud. Involuntary "hospitalization" and forced "treatment" are not part of a medical specialty which applies scientific knowledge to help people with their problems in thinking, feeling and behaving. Forensic psychiatry is an unnecessary, cowardly excuse for justice. It merely wastes human talent, blood and treasure. 

Read a few months' worth of progress notes for any individual. They will be over-obviously about almost nothing but how the person screws up, functions poorly, is mentally sick. But there is no real disease, there's only the fact that the clinicians writing these things don't like psychiatric patients, don't understand them, have no empathy, and don't know what to do with them.

The best example I can cite, perhaps, is Gus, who has been told repeatedly over some years, that nobody likes him. His psychiatrist, Dr. Vikramjit Gill, told Gus in so many words that he is the most disliked patient at EMHC. There's no way Dr. Gill would have said that directly to Gus (and I've heard him do so, myself, in monthly staffings when I was present), if he hadn't said it many times to other staff first.

Gus has been stigmatized, so he gets picked on, attacked and neglected. This is exactly what the JAMA commentary is about. Stigmatizing patients creates a degraded and unsafe standard of care in any medical institution. Gus has repeatedly suffered from medical conditions that probably would have been avoided or quickly remedied anywhere other than EMHC.

But psychiatric institutions are not so medical, at least not in the sense of real hospitals. They are a special case. They only stigmatize patients.

That's their business.

Heartless precarity

New York Times writer Michelle Goldberg claims that dealing with health insurers brings out the "heartless precarity of American life." This is a nice turn of phrase. (I looked up precarity which seemed like an unusual word. It means the state of being precarious or uncertain.)

But what's the real reason people feel uncertain when they think about or deal with health care? It's not that our American system is uniquely capitalist, unfair, or too expensive and unpredictable. We will never fix that. The real reason is that we Americans have uniquely come to believe that scientific medicine is the best route to salvation for an individual. This is a false belief which confuses and complicates everything for us. 

Psychiatry is the ultimate proponent of the false belief. Mental health professionals are dedicated, or labor under deference, to the proposition that each of us is merely a brain. 

Jon Franklin wrote going on four decades ago, that our deepest thoughts, our every emotion, our aspirations to love, to nobility and goodness, or to hateful revenge and evil domination alike, are all nothing more than complex reactions between neurotransmitters and receptors, interplay between the molecules of our minds.

In my opinion, this is the most vital issue raised by antipsychiatrists, variously exemplified by Thomas Szasz, Big Phil Hickey, and Laura Delano, among many others for whom I have huge admiration. Their personal beliefs may differ from my own in ways that I don't know at all, but we almost certainly agree that psychiatry is the most destructive cultural influence in human history, at least since the Inquisition.

Racism might be the closest runner-up to psychiatry, but as I read history they're merely arms of the same evil social body. Who could believe another person was less human because their skin was a different color, without accepting the fundamental falsehood that humans are all merely bodies, nothing but mud to begin with?

While we hold onto the false psychiatric belief our lives will continue to be full of precarity, and we will accuse random and unknown others of being heartless. Medicine is a good tool to alleviate suffering. It can be used more effectively than it is being used here and now. But we will still suffer, and we will still pay through the nose. As one song I heard long ago says, "We could laugh, or cry, or even say goodbye ...and know these bodies crumble through the years."

Maybe we will become a society that approves of a political policy for murdering fathers who work at health insurance companies.

Mangione, Goldberg and Malis are prophets of doom.

Psychiatria delenda est!

Incompetence and bad manners

There's a saying, never blame or allege bad or conspiratorial intent for situations that are just as easily explained by incompetence.

From my experience, this should be a major stable datum for understanding the Illinois forensic mental health system. I probably do not repeat it frequently enough to my clients, who hate the plantations and tend to see evil motives in everybody they deal with. I have two examples from yesterday and today.

At a staffing for Adrian, social worker Dan Malone was bound and determined to make the patient feel like he was wrong for refusing to have his vitals checked or to be physically examined. Adrian had told staff he didn't want that "service" several times, but they continued to bug him, thinking he might change his mind or comply just because they kept after him about it. I spoke up, to point out that of course Adrian had a perfect right to refuse any such medical attention, and Malone admitted it but responded very pointedly: "And that's why we didn't make him do it, because he has a right to refuse..." 

I'm not saying Malone's tone was hostile. He did not add, "...you fucking idiot Kretchmar," but his attitude was arrogant and dismissive. I'd rather be straight-out called a fucking idiot than talked down to, any day.

Everybody can be forgiven for having a bad morning and being a little impatient occasionally. At least, everybody except psychiatric slaves. When Adrian gets impatient it gets charted, and the chart notes can be used in court to help prove he's too mentally ill and dangerous to have any privileges or liberty.

Malone insisted on asserting that the only reason Adrian was being harassed by staff for a physical exam or vitals check was for his own good. People went after him and incessantly asked him to comply because they care about his health. This was Malone's nonsense, of course. People harassed Adrian to get his vitals checked or to have a physical exam because they believed it was proper according to the clinical ritual they follow. After all, medicine über alles, right? Everyone should be happy to have their vitals checked repeatedly all the time, and get a complete physical annually, right? Anybody who doesn't agree with and religiously observe those sacred rituals probably has Prodromal Anosognosia (see DSM-5 diagnostic criterion B).

Dan Malone is some sort of clergy of the psychiatric faith. He knows what's best for Adrian much better than Adrian does. His motives cannot be questioned, even if his manners are plainly bad. After going on about how staff's concern for the health of patients was the only reason Adrian was asked if he wanted a physical exam or his vitals checked, Malone proceeded to question Adrian in a very condescending and insistent way (almost like, "What's wrong with you?") about why he would ever refuse these wonderful, helpful medical services provided by such perfectly professional, medical mental health staff.

Adrian didn't have much of an answer, but Malone kept going on, and I finally told him brainwashing was unnecessary. He didn't like that very much. He doesn't believe they do brainwashing at EMHC, but he's wrong. Anyone who doubts it should read Robert Jay Lifton's Thought Reform and the Psychology of Totalism: A study of "brainwashing" in China (Chapel Hill: University of North Carolina Press, 1961). Psychiatric slaves recognize Lifton's descriptions of the Chinese techniques instantly, and staff on the plantations would, too, if they were able to be honest. They can't be honest though, they have to lie to themselves all the time. They probably can't read that book either.

Which brings up the incompetence factor. These people are mostly semi-literate cogs in a machine, pretending to be doctors specializing in the medical treatment of behavior. It's too obvious to almost everyone that they get poor or zero (or harmful) results, for which the taxpayers would never knowingly foot any bill. Dan Malone can't get any handle on Adrian, he can't help this patient, so he just has to blame him, disrespect him, despise him. It's not hard to see that, sitting in the room. It's not like Adrian misses it, either.

Meanwhile, over on N Unit, Gus was recently prescribed a heart monitor because his migraine meds might be having serious cardiac side effects. The cardiac doctor at UIC carefully instructed Gus on exactly how to use the monitor. He also mentioned that he didn't trust the data he was getting from EMHC, so he wanted Gus to take the monitor on and off himself, exactly as instructed. Later at EMHC, Dr. Seema Khan wouldn't let Gus do it, and wouldn't listen to Gus about how to do it. Who knows? Hopefully Gus isn't being denied appropriate medical care for a serious heart condition.

Everybody (staff anyway) at EMHC has to prove they can fight Gus. His social worker Joseph, who is supposed to be on a different unit but comes to N just to fight Gus, told him today that his packet for conditional release has gone to the court. But he refused to say when, or how he knows. A packet that recommends conditional release is a big deal; Gus has been waiting a long time for his packet to work its way through administration, his treatment team, second level review.... It probably should have been in court a couple years ago. In fact, comments by none other than the Almighty Statewide Forensic Medical Director, James Patrick Corcoran himself, suggested that Gus was ready for manumission long ago.

I told Gus to question Joseph closely about the conditional release packet, because a casual statement like, "...it has gone to the court," might be true or it might be just Joseph trying to get Gus to leave him alone. Gus needs to confer with his lawyer about an actual petition for conditional release, so he needs to be sure Joseph's news is accurate. He also needs documents, etc., to support a petition. (Tony Dillard wants to charge him a dollar/page for them though. That's suspiciously steep, to say the least!)

So Gus tried to ask Joseph politely, "When did that packet actually go to the court? What day did it get filed? How do you know?" Joseph simply refused to answer in any way at all, which makes no sense unless he was lying to Gus about the packet, which seems pretty likely to me.

But incompetence explains all of this at least as well as bad motive.

Decent manners would help.

The thing about apologies & retractions

Apologies can be sincere or insincere, and still make no difference in how anybody feels about an offense. 

Retractions likewise might have no impact at all, because the truth remains the truth, and lies remain lies.

There was once a "patient" at EMHC who was nicknamed Wookie or Scooter or Nookie or something else cute (I'm not sure what). He's long gone from the plantation by now, maybe very few people remember him. This guy accused one female staff of giving him crabs. (I looked up "crabs" to be sure I knew what it meant. It's gross, but if somebody accuses somebody else of giving them crabs, suffice it to say that does mean the accuser is saying he had sex with the accused.)

So... Wookie/Scooter/Nookie/whatever apparently had sex, or at least claimed or imagined that he had sex, with a female EMHC staff who shall go unnamed here. The allegation was investigated and the female staff was not fired. Perhaps she had some disability (other than crabs, that is) and EMHC/IDHS felt sorry for her.

But as I have said many times, when a staff in an IDHS institution has sex with a patient who is involuntarily committed for "treatment" of mental disorders which supposedly caused a crime, that staff commits a new crime. It's a serious crime, too, one that might earn the staff a prison sentence, and just about always should. I cannot fathom why anyone with any professional status or ability would ever choose an EMHC "patient" for sex. It is almost entirely incomprehensible to me. 

But apparently lots of IDHS staff do want psychiatric slaves for sex. Is there anyone reading this who has not heard credible rumors about some such "relationship" (terrible lying word for it!) at EMHC? Never mind whether you reported that suspicion to OIG within four hours... tragically, almost nobody does that!

And just by the way, another thing I cannot fathom is the concept itself, of "meaningless sex." In my own experience (which may be embarrassingly limited), that's an oxymoron. I was never jubilantly promiscuous, I always worried about it. Even a flirty look or a mostly social kiss and hug might be meaningful, and can often be memorable. Therein lies the problem. Sex is extremely powerful: it's a lot like LSD (the tiniest bit can cause huge effects), as anybody who ever had any knows. It's never meaningless or entirely free.

The female staff who had sex with Wookie/Scooter/Nookie many years ago has probably been a perfectly good girl ever since. But I guarantee she remembers him. I understand that, and I sympathize. She should rat out others, there are many.

Everyone should be interested. Everyone is.